Oral Finasteride Vs. Topical Finasteride - What's the Difference?

What Is Finasteride and What's Its Role in Hair Loss?

Finasteride belongs to a group of drugs called 5-alpha reductase inhibitors. Finasteride can be used to treat hair loss but is also used to treat an enlarged prostate, known as benign prostatic hyperplasia.

Finasteride is used in male androgenetic alopecia also known as male pattern baldness. It is a widely available treatment that can be purchased without the need for an appointment with your GP. It is licensed for use in androgenetic alopecia in men and is available in tablet form as a once-daily dosage.

Male pattern baldness is a common condition that affects at least 50% of British men over the age of 50. For some men, this can occur a lot earlier in life. Studies have shown that 90% of males treated with finasteride experienced benefit with the hair loss treatment. In another study, men who took finasteride saw an increase of hair counts by 10% at the end of their first year of treatment. Finasteride can also prevent further hair loss when treatment is adhered to alongside a healthy hair care routine.

What You Should You Know About Oral Finasteride

Finasteride is a 5 alpha-reductase inhibitor used to treat male pattern baldness. It works by blocking the conversion of testosterone to the hormone dihydrotestosterone (DHT). Increased DHT activity at the hair follicle is responsible for the hair loss. High levels of DHT can shrink the hair follicles and shorten the hair growth cycle, which results in loss of hair. DHT can also prevent nutrients from being absorbed by the hair follicles which leads to shrinkage and then fall out.

Oral finasteride is available in tablet form. It is a 1mg daily dosage. Once started, therapeutic effects can be seen within three to six months, provided treatment is adhered to. Finasteride can be seen to have benefits in 9 out of 10 men. If the medication is stopped, the effects will also cease and new scalp hair may be lost within a year of stopping the treatment.

As with all medication, taking oral finasteride may present side effects and risks associated with its use.

Side effects include:

• Sexual dysfunction e.g. erectile dysfunction, decreased libido, ejaculation problems.

• Breast swelling or tenderness.

• Rash.

Any changes concerning breast tissue such as lumps, pain, enlargement or nipple discharge must be reported to your doctor immediately as these could be signs of breast cancer. Breast cancer has been reported with the use of finasteride.

For an extensive list of side effects, please see the patient information leaflet.

If you develop an allergic reaction to finasteride, stop taking it and seek medical attention immediately.

Symptoms of an allergic reaction include:

• Skin rashes, itching, hives.

• Swelling of the lips, tongue, throat or face.

Oral finasteride is designed for men only. If you have a female partner who is pregnant or may become pregnant, she must avoid exposure to your semen as finasteride may be present in it. Finasteride can affect the normal development of the sex organs of an unborn baby. Women must not touch or handle, broken or crushed finasteride tablets.

How Does Topical Finasteride Work?

Topical finasteride has been shown to clinically and significantly reduce both plasma and scalp DHT in men with androgenetic alopecia. The topical finasteride formulation contains two active ingredients - finasteride and minoxidil - clinically proven hair loss ingredients. The spray contains 0.3% Finasteride and 6% Minoxidil. It is to be used daily either in the morning or 30 minutes to 1 hour before bed.

Topical finasteride is an off-label product which means it has not been licensed for hair loss, unlike oral finasteride. The product is intended for use in men only.

Topical minoxidil can be found in products such as Regaine and has been proven to treat male pattern hair loss. Topical minoxidil stimulates hair growth by increasing the supply of blood and nutrients to the hair follicles. It also reverses the miniaturisation of the follicles and extends each follicle growth phase. Topical minoxidil can display therapeutic effects in as little as eight weeks.

Finasteride does have side effects, but when using it topically, those side effects are reduced which is why some men prefer it over the oral tablet. This is because there is less systemic exposure and the topical version is only applied to the site where its effects are required.

Topical finasteride treatment has proven to be effective in male patients. Its effectiveness is similar to oral finasteride but is preferred due to its lower systemic exposure. Scalp DHT was reduced by 68-75% with topical finasteride compared to oral finasteride at 62-72%. However, topical treatment was absorbed at around 10 to 15 times lower than the tablet.

The side effects of topical finasteride include:

• Lightheadedness.

• Conjunctivitis.

• Headaches.

• Oropharyngeal pain.

It is still possible to experience the side effects of oral finasteride whilst on topical medication, but the probability is lower due to less systemic exposure.

How to Apply Topical Finasteride?

1. Hold the bottle two to three inches away from the head. It is a good idea to part the hair slightly so the solution can reach the scalp.

2. Spray the prescribed number of sprays across the zones of hair loss - it may seem like you don't have enough but you do not need to drench your head in the solution for it to have effect.
   You may want to tilt your head back slightly to avoid it dripping down onto your face. Any excess that has accidentally run down your face can be blotted away with a paper towel and then washed with gentle soap and water.

3. Once sprayed, massage the solution into the scalp.

4. Let the solution dry and wash your hands thoroughly. Do not wash the scalp for at least 4 hours after application.

What Are the Major Differences Between Oral and Topical Finasteride?

Effectiveness

Both formulations are effective when treating male pattern hair loss. The topical solution has slightly higher percentages of beneficial effects when tested in healthy male volunteers.

Side effects

The side effects are slightly more severe with the oral form as there is more systemic exposure. Systemic exposure refers to the medication being absorbed inside the body rather than being applied to a specific area of the external body. Side effects can also be more widespread with the oral form. The topical spray does have its side effects which are more local to the area of treatment e.g. light-headedness and conjunctivitis.

Convenience

The oral medication can be considered more convenient as it has a very minimal routine. The tablet is to be taken once daily at around the same time each day with a sip of plain water. The topical solution has a more time-consuming routine. The solution must be washed off daily after being left on the scalp for a minimum of four hours. It is safe to leave the solution on overnight. Topical finasteride is unsafe for pregnant women or women who are trying to conceive. If your partner falls into this category and you wish to leave topical finasteride on overnight, avoid sharing a pillow and take precautions to reduce their exposure to the medication.

Does Topical Finasteride Perform as Well as the Oral Version?

Topical finasteride performs as well as and even slightly better than its oral form. Studies conducted have shown that 3% of more patients responded to topical finasteride vs oral finasteride. Topical finasteride appears to be more popular due to its lower side effect profile.

According to a study conducted in 2014 by the International Journal of Clinical Pharmacology and Therapeutics, they found that Plasma DHT was reduced by 68-75% with the topical solution and by 62-72% with the tablet.

The oral form is much easier to administer as it does not require daily hair washes or a messy application process.

Another study between a finasteride gel and an oral tablet revealed that both forms are very similar. In the controlled clinical trial of 45 males with androgenetic alopecia, half used the gel and half the tablet. The comparisons were based on terminal hair counts, balding area sizes and hair counts. Between the groups, there were no significant variations between the hair thickness, hair counts or the side of the bald area. The findings confirmed the finasteride gel and tablet form were similar in efficacy.

How Can Quick Meds Guide You in Choosing Between Oral and Topical Finasteride?

Here at Quick Meds, we can guide you to make the right decision for male pattern hair loss. We can offer you a confidential, free consultation to go through all the benefits and risks of each formulation.

Factors to take into account are if you have a partner who is female and you plan on having children. Oral finasteride can pass into the semen which can then harm an unborn child.

It is important to consult with an appropriate healthcare professional before deciding to start any medication that you have not had before. You may be at an increased risk of certain side effects or maybe using other medication that may interact with finasteride, it is best to speak with someone regarding all your medical history so they can help you navigate towards the best treatment to treat hair loss.

Start your hair loss consultation with the Quick Meds team today.

How to Decide Between Oral and Topical Finasteride?

Deciding between formulations may be tricky, but we can help you explore the options and offer you advice which can help you to conclude. If you are unsure, consult a professional for medical advice as this service is not suitable for everyone.

The main differences between the two are; side effects and ease of administration. Whilst the solution may be messier to apply and requires regular washing, the oral version can cause more undesirable side effects. Here at Quick Meds, we can help you to understand which may be better for you and more convenient for your lifestyle.

Before starting any new medication, it is very important to speak to a healthcare professional. Finasteride has undesirable side effects and there are cautions to be aware of when using this medication. Our efficient team of pharmacists can talk you through all the key points you need to know before deciding on starting treatment for male pattern baldness.